- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.29 / $18.46 / $23.69
| Facility | | $16.29 | $18.46 | $23.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.64 / $17.64 / $17.64
| Professional | | $17.64 | $17.64 | $17.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.71 / $23.69 / $23.69
| Professional | | $15.71 | $23.69 | $23.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.09 / $42.33 / $49.55
| Professional | | $32.09 | $42.33 | $49.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.73 / $23.69 / $29.61
| Professional | | $19.73 | $23.69 | $29.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8.28 / $23.69 / $38.33
| Professional | | $8.28 | $23.69 | $38.33 |
University Health Alliance - Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.11 / $35.86 / $49.66
| Professional | | $22.11 | $35.86 | $49.66 |